Liver, GB, pancreas Flashcards
how can the liver respond to injury?
1) degradation of hepatocytes
2) Necrosis
3) Inflammation
4) regeneration
5) Fibrosis
An excess of ______ causes Jaundice. what blood concentration must be reached for diagnosis?
Excess bilirubin
> 2.0 mg/dl
what is the etiology of jaundice?
overproduction of blilrubin, reduced hepatocyte uptake, & obstruction of bile flow
____________ are the number 1 cause of jaundice
Hemolytic anemias
what is the difference between unconjugated, and conjugated, bilirubin?
Unconjugated-virtually insoluble, toxic
Conjugated-soluble, nontoxic
what is icterus?
yellowing of the sclera
what is the definition of hepatitis?
hepatocyte injury that is associated with inflammation
what are the etiologies of hepatitis?
hepatotrophic viruses
autoimmune
drug
toxic agents
Hepatitis ________ infections are characterized as: Benign, self-limited infection, no chronic or carrier state
Hepatitis A
How is Hepatitis A transmitted? what is the incubation time? What type of virus is it?
- RNA virus
- Fecal or oral transmission
- Incubation 2-6 weeks
Hepatitis B is caused by what type of virus? how is it spread? what is the incubation time?
DNA virus
Parenteral / sexual spread
Incubation 30-180 days
what are the 3 types of Hepatitis B infections?
Carrier, chronic, cirrhosis
what type of cancer can be caused by hepatitis B?
Hepatocellular carcinoma
T/F: most infections of Hepatitis B lead to cirrhosis or chronic hepatitis
FALSE
95% are self-limiting
what are the “hallmark” features of Hepatitis C?
Persistent infection + chronic hepatits
found in 85% of cases
what virus type is Hepatitis C? whats its incubation time?
- RNA virus
- majority of infections progress
- Incubation 7-8 weeks, acute phase asymptomatic
why is there no available vaccine for hepatitis C?
Hepatitis C has a lot of genomic instability
keeps mutating
what are the histological characteristics of an ACUTE viral hepatitis infection?
Panlobular disarray, Inflammation, Hepatocyte necrosis
condition resolves in 8 weeks
which hepatitis strains are most likely to cause a “Fulminant “?
(Fulminant = mass liver necrosis, results in acute liver failure)
** Hepatitis C
- Hep B can also cause it
what is the definition of chronic hepatitis?
Abnormal liver function for >6 weeks
Hepatitis B induced liver disease is an important precursor for _________
HCC
hepatocellular carcinoma
what determines the ultimate outcome for Hepatitis B?
Host immune response
Hepatocyte damage likely reflects CD8+ cytotoxic T cell damage to Hepatitis B infected hepatocytes
an infection with Hepatitis ____ does not increase liver enzymes such as serum aminotransferases
Hepatitis G
the pathology of autoimmune hepatitis is associated with what?
T-cell mediated autoimmunity
Alcoholic liver disease is caused by the overlapping of what 3 conditions?
1) hepatic steatosis (fatty liver)
2) EtOH hepatitis
3) cirrhosis (fibrosis + nodules)
what condition is associated with “Mallory” bodies in the liver?
fatty liver (from alcoholism)
AND
alpha-1 trypsin defeciencies
what are mallory bodies?
- clumps of cytokeratins
- eosinophilic
______________ is the most common non-alcohol fatty liver disease
Metabolic liver disease
in cases of cirrhosis, there will be histological evidence of bridging ______
septae
what are the symptoms of Portal hypertension from cirrhosis?
Ascites
Collateral venous channels
Splenomegaly
what causes hemochromatosis ?
1) excess Iron: accumulation in liver, pancreas, heart
2) genetic
what is the most common type of genetic hemochromatosis?
most common is Homo-zygous recessive
- mutation on Chromosome 6
what is the morphology of hemochromatosis?
Hemosiderin
Fibrosis
name the “classic triad” associated with hemochromatosis
1) micronodular cirrhosis
2) diabetes mellitus
3) skin pigmentation
what causes Wilson’s disease? what organs does it effect?
A) Autosomal RECESSIVE disease
B) results from a failure to incorporate copper (Cu) into ceruloplasmin
C) Copper accumulates in liver, brain, eyes
what is the clinical presentation for Wilson’s disease?
- acute or chronic liver disease. May present with tremor or behavioral changes
- presents between 6 to 40 years of age
what is the treatments for Wilson’s disease?
1) Chelation
2) D-Penicillamine (immunosuppressive drug)
why can a serum screening for concentrations of Copper (Cu) NOT be used to diagnose Wilson’s disease?
what should be used instead?
- serum levels may actually be low
- instead use Cu levels in urine (good for screening) or Cu levels in liver (definitive diagnosis).
what develops from an alpha1-antitrypsin deficiency?
- develop pulmonary emphysema from protein degrading enzymes
- Also develop liver disease
Intrahepatic Biliary Tract Disease includes what 3 conditions?
1) secondary biliary cirrhosis
2) primary biliary cirrhosis
3) primary sclerosing cholangitis
_____________ cirrhosis results from obstruction of extrahepatic duct
Secondary biliary cirrhosis
what are the risk factors for Cholesterol stones and Pigment stones?
(Cholelithiasis risk factors)
Cholesterol:
- caucasians
- age
- females (increased estrogen)
Pigment:
- hemolysis
- blood disorders
- biliary dysfunction
what is Primary biliary cirrhosis (PBS)? what does it affect?
Inflammatory autoimmune disease
affects intrahepatic bile ducts
what is the primary feature of PBS?
primary biliary cirrhosis
nonsuppurative inflammatory destruction of medium sized intrahepatic ducts
what are the characteristics of Primary sclerosing cholangitis (PSC)?
- Fibrosing cholangitis of bile ducts
- develop luminal obliteration
- Liver eventually develops biliary cirrhosis
T/F: Primary biliary cirrhosis, secondary biliary cirrhosis, AND Primary sclerosing cholangitis all have the SAME endpoint
true
what are the characteristics of Cholangiocarcinomas?
Cholangiocarcinoma = Adenocarcinoma of gallbladder
- arises in bile ducts within and outside the liver
- VERY aggressive, asymptomatic till late stage
what are the histological characteristics for hepatocellular adenomas?
bland hepatocytes and no bile ducts
______________ is the 3rd leading cause of cancer deaths worldwide
hepatocellular carcinoma
what are the etiological factors for hepatocellular carcinoma?
chronic viral infection (HBV, HCV)
chronic alcoholism
NASH (nonalcohol steatohepatitis)
food contaminants (primarily aflatoxins).
what form of Hepatocellular carcinoma is more likely to form in young men and women?
Fibrolamellar Carcinoma
T/F: Fibrolamellar carcinomas have a worse prognosis than hepatocellular carcinomas
FALSE
better prognosis for fibrolamellar
Fibrolamellar carcinomas are associated with “________ tumors” meaning they form hard masses with fibrosis
“Scirrhous” tumor
what type of hepatic cancer is generally fatal within 6 months of diagnosis?
Adenocarcinoma of gallbladder
- AKA Cholangiocarcinoma
- poor prognosis due to insidious onset
what are the 2 primary soft tissue sites for metatases to occur in the body?
liver and lungs
they get the most blood
why is hepatomegaly usually the only sign of a malignant cancer in the liver
liver has a massive functional reserve
it can sustain a lot of damage without showing clinical signs
T/F: men are more likely to develop Cholelithiasis (gall stones) than women
FALSE
- women are twice as likely to have them
what factors increase the formation of cholelithiasis (gall stones)?
- Increased with estrogen (pregnancy and oral contraceptives)
- Increased with gall bladder stasis
- Hereditary contribution
while 70-80% of patients with gall stones remain asymptomatic, what are the possible symptoms when they occur?
A) develop colicky biliary pain
B) may eventually note perforation
C) obstruction of gall bladder or erode into ileum
D) develop GI obstruction
_____________ Almost always occurs in association with gallstones
Cholecystitis
inflammation of the gall bladder
what are the clinical symptoms of ACUTE Cholecystitis?
** Severe Right Upper Quadrant pain
Chemical, bacterial, reflux-ischemia
MOs later in course
what are the types of cholecystitis?
Cholesterol (85% radiolucent)
Bilirubin (50-75% radiopaque)
what 3 conditions cause pigmented gall stones (cholecystitis)?
Hemolysis
GI disorders
Biliary infection
T/F: chronic cholecystitis is usually associated with vague symptoms, and fibrosis/inflammation of the gall bladder
true
what group is at the highest risk for Gall bladder Adenocarcinomas?
70 years old
Whites > blacks
F > M
95% of adenocarcinomas of the gall bladder are associated with __________
gallbladder stones
what are the endocrine functions of the pancreas?
regulates glucose homeostasis via insulin & glucagon
what are the exocrine functions of the pancreas?
A) critical for food digestion B) Pancreatic enzymes include: - amylase - trypsin & chymotrypsin - lipase
what 3 conditions are responsible for 80% of all Acute pancreatitis cases?
Cholelithiasis (gall stones)
Biliary Tract Disease
Alcoholism
what is the definition of pancreatitis?
reversible parenchymal injury associated with inflammation
what is the MAIN clinical symptom of pancreatitis?
ABDOMINAL PAIN
“upper back intense pain”
why is severe pancreatitis a medical emergency?
due to potential of pancreas to release toxic enzymes
what enzymes are elevated during pancreatitis?
1) Amylase
2) Lipase
what occurs during chronic pancreatitis?
Progressive destruction exocrine pancreas, later stages lose endocrine
what are the possible causes of chronic pancreatitis?
- Alcoholism
- Biliary disease
- Hypercalcemia
- Hyperlipidemia, Oxidative stress
what are the morphological features of chronic pancreatitis?
Reduced acini Chronic inflammation Fibrosis Obstruction ducts Spare islets
why is a serum test for amylase levels NOT good for diagnosing chronic pancreatitis?
disease may have already destroyed acinar cells, so may not see an increase in serum amylase
Close to 95% of Pancreatic cystic neoplasms arise in what population group?
women
most carcinomas of the pancreas of are what type?
Adenocarcinomas
makes sense- its a gland
Pancreatic Exocrine Tumors are the _____ leading cause of cancer death in the U.S.
4th
lung, colon, breast, pancreas
what is the precursor lesion for pancreatic cancer?
pancreatic intraepithelial neoplasias
AKA- “PanINS”
what age group is most likely to develop pancreatic cancer?
60-70 year olds
T/F: most patients diagnosed with pancreatic cancer die within 6 months
TRUE
- has “silent growth” and is usually not identified until advanced stages
____________ doubles the risk of developing pancreatic cancer
smoking
besides smoking, what are the 2 other risk factors for pancreatic cancer?
diabetes mellitus
chronic pancreatitis
what is the precursor lesion for pancreatic carcinomas?
pancreatic intraepithelial neoplasias
AKA- “PanINS”
what age group is most likely to develop pancreatic carcinomas?
60-70 year olds
T/F: most patients diagnosed with pancreatic carcinomas die within 6 months
TRUE
- has “silent growth” and is usually not identified until advanced stages
carcinomas in which portion of the pancreas will cause jaundice?
head of pancreas
- they can block common bile duct
which strains of hepatitis can transition into “carrier states”?
Hepatitis B, Hepatitis C
what is the result of Fulminant formation due to Hepatitis?
results in acute liver failure
this is rare
___________ is the 12th most common cause of death in the U.S.
Cirrhosis
- primary reason for death = liver death
